Frequently Asked Questions About Medicaid Eligibility, Applications and Geriatric Care Services

What is Medicaid?

Medicaid is a federally-funded program run by the state and the county, which provides medical insurance and long-term care for middle to low-income persons or to the elderly or disabled.

Who can apply for Medicaid?

Anyone can apply for Medicaid, however there are various income and resource restrictions. We can help you understand the restrictions as part of the application process making it clear as to whether or not you have a chance at elgibility.

What does Medicaid cover?

If eligible, Medicaid will pay for all medical care (including doctors & hospitals), prescriptions, home care and nursing home care.

What is the difference between Medicaid and Medicare?

Medicare is available to anyone over the age of 65 or to the certified disabled who have worked and paid into the Social Security system. Medicaid is based on income and resource levels, and although anyone can apply, eligibility needs to be approved. We work to maximize your chance of being approved and make the process as easy as possible by doing most of the work for you.

What can be done to protect a person’s or a family’s income and assets when elder-care services or Medicaid is necessary?

There are numerous programs and choices available to help pay for these services while still protecting your assets, income, homes and resources. We can work with you throughout the process to understand these programs further.

What files should I collect before my consultation?

Prior to your Medicaid eligibility consultation you should collect information that shows proof of age (birth certificate), four weeks of recent paycheck stubs (if employed), proof of income from sources such as Social Security benefits, Veteran’s Benefits (VA), retirement benefits or unemployment insurance benefits. If you own a home, the state may ask to see a current tax bill, a real estate appraisal or copies of your mortgage.

Does Medicaid have income limits?

Each state sets its own Medicaid eligibility guidelines. New York expanded its Medicaid coverage to low-income adults under the age of 65 who do not yet have Medicare, such as people on Social Security Disability. Those who did not qualify for Medicaid in the past are urged to reapply under the new expansion Medicaid rules.

Click here to view the NY Department of Health income ratio chart to see if you qualify for Medicaid and the amount of benefit you may receive.

How long does it take Medicaid to take effect after approval?

If you or your family member qualifies for Medicaid, you can expect to be on the Medicaid fee-for-service until you are transferred to a Medicaid Managed Care Plan (Blue Choice Option, Fidelis Care Option or MVP Option). This may take up to three months.

What is a Medicaid Pooled Income Trust?

Special Needs Trusts and Pooled Income Trusts can help individuals maintain eligibility for Medicaid and Supplemental Security Income (SSI). Both Medicaid and SSI have strict asset requirements so, when a beneficiary comes into new resources, he or she must handle them in a way that will not hinder their eligibility to these services. Click here to read more.

How is care provided through Medicaid?

Medicaid offers many different health plans for different types of care, including dental and geriatric. Medicaid is administered to those who qualify with certain financial requirements. Click here to view the NY Department of Health income ratio chart to see if you qualify for Medicaid and the amount of benefit you may receive.

Your program will assign you a doctor. If you already have a doctor, ask if his or her establishment accepts Medicaid. If you are looking for a doctor in your area who will take Medicaid, please click here or call the number on your Medicaid insurance card.

Will Medicaid cover my prescriptions, emergency room visit, or dental appointment?

Medicaid will not cover drugs that Medicare covers. In some limited cases, Medicaid may provide some coverage, but if you are worried about receiving prescriptions please look into a prescription drug plan.

Most Medicaid programs cover a hospital stay if the patient is sent to the emergency room after visiting with a doctor.

All New York State Medicaid programs cover “essential services” for dental. Please note that this is not the same as comprehensive care. Medicaid programs must provide children under the age of 21 with dental care, as is required by federal law.

How do I schedule a consultation with P & P?

Please fill out our contact form.